Notification of Changes for Business Entity
General Information
Business Entity Name:	WORLD FINANCIAL GROUP INSURANCE AGENCY
Incorporation / Formation Date:
FEIN:	95-3809372
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	ORANGE
Business Address
Address 1:	145 SOUTH STATE COLLEGE
Address 2:	SUITE 115-G
City:	BREA
State:	CA
Zip:	92821
Phone:	7704539300
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	11315 JOHNS CREEK PARKWAY
Address 2:	SUITE 115-G
City:	DULUTH
State:	GA
Zip:	30097
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
TRENT BROWN	35LKF	16934150		YES	08-09-2018
DEBORAH RUFFIN	35YSK	116779		YES	08-09-2018
GABRIEL JACKSON	37KCZ	14089345		YES	08-09-2018
TIMOTHY SCHAEFER	37PPP	15952460		YES	08-09-2018
JOEY TERRAZA	37RFX	17659749		YES	08-09-2018
SHAUN SMITH	38GYU	7900037		YES	08-09-2018
MATTHEW RADER	39FXK	15913696		YES	08-09-2018
NANCY PYON	39KAD	7368269		YES	08-09-2018
DAN CHAMBERLAIN	39PEL	4627329		YES	08-09-2018
GILLIAN HARRIS	40OSV	17726954		YES	08-09-2018
CHARLES BRASEL	42MXF	9904777		YES	08-09-2018
KATHERINE JOHNSEN	45IAK	17613125		YES	08-09-2018
DAVID SPEAKER	46VLC	17828910		YES	08-09-2018
MATTHEW POLETTI	46VRI	16961877		YES	08-09-2018
BEAU NORTON	45NJV	17364680		YES	08-09-2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)	NO
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?	NO
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	STEPHANIE HOSIER
Title:	DIRECTOR OF LICENSING
Phone Number:	7704539300
Email Address:	KEIL.YOUNG@TRANSAMERICA.COM